Provider Demographics
NPI:1992559140
Name:LEON, MAXWELL (RBT-24-340283)
Entity type:Individual
Prefix:
First Name:MAXWELL
Middle Name:
Last Name:LEON
Suffix:
Gender:M
Credentials:RBT-24-340283
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 KEY CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-2756
Mailing Address - Country:US
Mailing Address - Phone:407-508-6051
Mailing Address - Fax:
Practice Address - Street 1:1555 KEY CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-2756
Practice Address - Country:US
Practice Address - Phone:407-508-6051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-340283106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician